Despite risks, Molina gambles on Obamacare rewards

CNBC's Bertha Coombs takes a look at which insurance companies could be the biggest winners when the health care exchanges go live next week.

Molina Healthcare touts itself as an extended family to its Medicaid insurance clients. In keeping with that image, the company chose to feature its employees and their kids at a family picnic for its Obamacare enrollment campaign.

"We have been doing this for over 33 years," said Dr. Mario Molina, president and CEO. "So, we've developed a lot of trust, I think, in the community and that's going to be an important part of this."

Molina covers nearly 2 million Medicaid patients across nine states, including California, Texas and Florida. The insurer is offering plans on the new health insurance exchanges in all of those states. It has hired 2,000 people in the past year and is planning a major enrollment effort that includes retail storefronts in some of its biggest markets.

"We have kiosks in places that are available in shopping malls so that people can come in a nonthreatening way just to get information and not feel like they are getting the hard sell," said Molina.

The more important part of the outreach will involve staffers at its proprietary community health clinics. These staffers already come in contact with a high number of uninsured adult patients who may now qualify for subsidized coverage on the state health exchanges or free coverage under the Affordable Care Act's Medicaid expansion program.

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At a training session at a Molina health clinic outside San Bernardino, Calif., nurses, doctors and nurse practitioners were told how important it will be for them to encourage those patients to get enrolled this fall.

"Right now, California is the flagship for the entire Molina enterprise," said Ruthy Argumedo, who led the training session. "We're projecting 94,000 individuals that we will be able to target."

Molina expects the combination of Medicaid expansion and exchange enrollment will help it double annual revenue from $6 billion to more than $12 billion by the end of 2015.

Barclays analyst Joshua Raskin said he expects the new exchange business could be a significant game changer for Molina.

"We've got projections that they can add as many as 100,000 lives in California alone," Raskin said. "For that size company, exchanges could certainly be a nice increase on their top line."

But enrollment growth may not translate into profits, which is why some of the larger insurers like United Healthcare and Aetna have been cautious about selling plans on the new exchanges. Pricing premiums low enough to be attractive to enrollees leaves little room for error.

"Just small shortfalls on the margin side can pressure earnings," said Chris Rigg, an analyst with Susquehanna.

"The biggest risks are a broad-based mispricing, or said another way, adverse selection, where only the sickest individuals sign up for insurance," he explained.